Healthcare

Mainers earn the ‘Right to Shop’ for medical services

Due to the hard work and dedication of a number of conservative leaders across the state, Maine recently enacted a major reform of its healthcare system that will reduce costs and enhance competition in the market.

Gov. Paul LePage signed into law on Monday a bill that gives Maine citizens the “Right to Shop” for a variety of medical services, saving money for both consumers and insurers.

LD 445, sponsored by Sen. Rod Whittemore, R-Somerset, requires health insurance companies offer plans that allow patients to shop for comparable services and provides incentive for them to peruse the healthcare market for treatment that best fits their budget. If a patient finds and receives care for less than the average cost to their insurer, both the patient and insurance company split the savings. In other words, when patients purchase less expensive treatment from out-of-network providers, the savings can be applied as credits toward copayments or insurance deductibles as if it was an in-network provider, or returned in the form of a cash payment.

As a result of LD 445’s passage, consumers in Maine can now shop for treatment under four categories of services: physical and occupational therapy, radiology and imaging, laboratory and infusion therapy services.

“In America, we have some of the best health care in the world, however the cost of this care has reached a point where affordability has become a huge hurdle for most of our citizens,” Sen. Whittemore said in a press release.

Not only does this allow consumers to receive the same high-quality care at a lower cost, it gives them more choice and control over the services they consume, making the healthcare market more competitive.

The cost of individual medical services varies greatly throughout Maine. A study published by the Maine Heritage Policy Center highlights these discrepancies in great detail. As of April 2016, the maximum cost of a knee replacement in Maine was $50,454, while the same service could be delivered elsewhere in the state for just $26,743. The cost of natural child delivery ranged from $5,402 to $13,428, and the removal of cancerous tissue varied anywhere between $113 and $551.

Sen. Whittemore’s bill addresses this issue by establishing an online price transparency shopping tool that compiles available pricing data for consumers to review before choosing where to receive treatment. It also creates a toll-free number patients can call to obtain information regarding the cost of services at different facilities throughout the state.

With patients capable of searching for cost-effective services, hospitals will begin competing for business by lowering their prices. This could benefit critical access hospitals in rural areas of Maine that have struggled to attract enough patients to remain financially viable.

“Encouraging consumers to seek lower cost high quality health care, and rewarding them for doing so, will create constructive competition among healthcare providers. This will also have a positive impact on lowering the overall cost of healthcare, which will ultimately lower insurance premiums.”

Providers must now establish shared savings incentive programs and notify patients of their right to shop for services by 2018.